More evidence hormone patch is safer than pills

NEW YORK (Reuters Health) - A new study adds to evidence that skin patches offer a safer alternative to pills for women who want to treat their menopausal symptoms with hormones.

The study, of 54,000 women who used hormone replacement therapy (HRT), found that those who used estrogen patches were one-third less likely to develop blood clots in the legs or lungs.

That was in comparison to women who used estrogen-only pills. Past studies have found that hormone-patch users have a lower blood clot risk than women who take oral HRT containing both estrogen and progesterone.

But more importantly, the current study gives a snapshot of what's going on in the "real world," according to lead researcher Patrick Lefebvre, of Analysis Group, Inc. in Montreal, Canada.

Most of what's been known about the blood clot risks of estrogen patches has come from clinical trials, Lefebvre told Reuters Health in an email.

The current findings are based instead on health insurance claims from just over 54,000 women who used HRT at some point between 2002 and 2009.

"Our study corroborates the literature with data from the real-world setting," Lefebvre said.

The number of women using HRT plummeted in 2002 after a large U.S. clinical trial found that women on estrogen-plus-progesterone pills had higher risks of blood clots, heart attack, stroke and breast cancer than placebo users did.

Up to that point, HRT had been prescribed to prevent heart disease and osteoporosis -- which experts now advise against.

However, hormone therapy remains the most effective way to ease menopausal hot flashes, so some women with severe symptoms opt for it. Because of the risks, they are advised to use HRT at the lowest dose and for the shortest time possible.

There is growing evidence, though, that low-dose patches may not carry all the risks that pills do.

Researchers think hormone patches may be less risky than pills because of the way they work. Unlike oral hormones, those delivered via skin patch bypass the liver, and may not boost clot-promoting proteins in the blood.

In the current study, women used hormone therapy for just over a year, on average.

Of the roughly 27,000 women who used estrogen-only pills, 164 developed blood clots in the leg veins or the lungs -- for a rate of almost 0.6 percent per year. Of the 27,000 women who used estrogen patches, 115 developed a blood clot -- a rate of 0.4 percent each year.

Blood clots in the lungs are potentially fatal. Clots in the legs are dangerous as well, because they can break off and travel to the lungs, or to arteries supplying the heart or brain, where they can trigger a heart attack or stroke.

Coupled with past studies, the new findings suggest that for women who want to try hormones to ease hot flashes, patches could be a safer alternative.

However, the patches tend to be more expensive than the pills, which usually cost less than $15 a month for generic versions.

But Lefebvre said the bottom line for women is to be aware that there are different options for managing menopausal symptoms. "The decision on how to treat must be an individual one based on discussion with your doctor."

Some women may be able to ease hot flashes with simple changes, like sleeping in a cool room and watching their intake of caffeine, alcohol and hot, spicy foods. And there's some evidence that yoga, meditation or other relaxation techniques can be helpful.

In some cases of more-bothersome hot flashes, doctors prescribe low doses of certain antidepressants. Vaginal dryness, another common menopause symptom, may be treatable with topical estrogen, which delivers much less of the hormone into the bloodstream versus pills.

As for alternative remedies for hot flashes, some studies have suggested that soy, black cohosh and other sources of phytoestrogens (plant-based estrogen-like chemicals) may help; other studies, however, have found no such benefit.